Soufiani Aida, Chraibi Hamza, El-Mhadi Samah, Agoumy Zineb, Fassi Fehri Zineb, Fellat Rokya, Bensouda Adil, Bendagha Nesma, Moughil Said
Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco.
Cardiovascular Surgery B Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco.
J Surg Case Rep. 2023 Mar 9;2023(3):rjad108. doi: 10.1093/jscr/rjad108. eCollection 2023 Mar.
Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging.
冠状动脉瘘（CAF）是罕见的异常情况，对诊断和治疗构成重大挑战。它们大多起源于右冠状动脉，且为先天性。它们常与冠状动脉瘤相关。我们报告一例38岁黑人男性病例，该患者因劳力性呼吸困难就诊。经胸超声心动图发现一个被认为是双侧心房包虫囊肿的病变，同时伴有右心房分流。心脏磁共振成像显示在T1和T2序列上呈低信号的囊性病变，位于左心房旁，以及一条迂曲动脉瘤样动脉向右心房分流。冠状动脉造影和计算机断层血管造影证实了双叶状迂曲囊状动脉瘤和CAF。患者接受了成功的手术，手术包括使用两片补片闭合瘘管。术后过程顺利，患者出院。我们的病例报告说明了CAF的诊断困难以及多模态成像的重要性。
